Purpura

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Skin hemorrhages

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Purpura (from the Latin, purpura, meaning “purple”) is the appearance of red or purple discolorations on the skin, caused by bleeding underneath the skin. Small spots are called petechiae, while large spots are called ecchymoses.

This is common with typhus and can be present with meningitis caused by meningococcal meningitis or septicaemia.

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Historical Perspective

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Classification

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Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Purpura is a common and unspecific symptom, however the underlying mechanism commonly involves one of the following;

Platelet disorders
- Primary thrombocytopenic purpura
- Secondary thrombocytopenic purpura
Vascular disorders
- Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
- Hypertensive states
- Deficient vascular support
- Vasculitis, as in the case of Henoch-Schönlein purpura
Coagulation disorders
- Disseminated intravascular coagulation (DIC)

There are also cases of psychogenic purpura described in the medical literature,^[1] some claimed to be due to “autoerythrocyte sensitization”. Other studies^[2] suggest, that local (cutaneous) activity of tPA can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding.

References

↑ Anderson JE, DeGoff W, McNamara M (1999). “Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature”. Pediatric emergency care. 15 (1): 47–8. PMID 10069314.
↑ Lotti T, Benci M, Sarti MG, Teofoli P, Senesi C, Bonan P; et al. (1993). “Psychogenic purpura with abnormallt cutaney increased tPA dependeny”. 32 (7): 521–3. PMID 8340191. Unknown parameter |journous fibrinolytic activital= ignored (help)

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Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Common Causes

Causes by Organ System

Cardiovascular	Acute infantile hemorrhagic edema, Churg-Strauss syndrome, Endocarditis, Fat embolism, Henoch-Schonlein purpura, Leukocytoclastic vasculitis, Vascular hemostatic disorder, Vasculitis, Wegener’s Granulomatosis , Septic emboli
Chemical / poisoning	Arsenicals, Iodides
Dermatologic	Acroangiodermatitis, Grey Turner sign
Drug Side Effect	Alemtuzumab, Aspirin, Atropine, Aztreonam, Chloral hydrate, Cilostazol, Cladribine, Corticosteroids, Co-trimoxazole, Dapsone, Febuxostat, Flurbiprofen, Glucocorticoids, Gold, Hydralazine,* Doxycycline, Hydrochlorothiazide Ketoconazole, Ketorolac tromethamine, Meprobamate, Oxaprozin, Oxcarbazepine, Pergolide,, Penicillin, Quinidine, Sulfasalazine, Sulfonamides, Sulindac, Tetracycline
Ear Nose Throat	No underlying causes
Endocrine	Cushing syndrome
Environmental	No underlying causes
Gastroenterologic	Liver disease, Vomiting
Genetic	Ehlers-Danlos syndrome, Ethylmalonic encephalopathy, Factor IX deficiency, Factor VIII deficiency, Hereditary haemorrhagic telangiectasia, Pseudoxanthoma elasticum, Schamberg disease, Tyrosinaemia, Von Willebrand’s disease
Hematologic	Aplastic anemia, Cryoglobulinaemia, Disseminated intravascular coagulation, Hemolytic uremic syndrome, Idiopathic thrombocytopenic purpura, Leukemia, Multiple myeloma, Thrombocytopenia, Thrombotic thrombocytopenic purpura, Factor IX deficiency, Factor VIII deficiency, Von Willebrand’s disease
Iatrogenic	Blood transfusion reaction
Infectious Disease	Brucellosis, Congenital cytomegalovirus, Congenital rubella, Dengue, Human monocytotropic ehrlichiosis, Leptospirosis, Measles, Meningococcemia, Neisseria gonorrhea, Neisseria meningiditis, Purpura fulminans, Q fever, Relapsing fever, Rickettsiae, Rocky mountain spotted fever, Scarlet Fever, Septic emboli, Typhoid, Typhus fever, Vibrio vulnificus, Endocarditis, Congenital cytomegalovirus, Congenital rubella
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Scurvy, Vitamin C deficiency, Vitamin K deficiency, Tyrosinemia
Obstetric/Gynecologic	No underlying causes
Oncologic	Solid tumor invading bone marrow, Leukemia
Opthalmologic	No underlying causes
Overdose / Toxicity	Alemtuzumab, Aspirin, Atropine, Chloral hydrate, Cilostazol, Corticosteroids, Co-trimoxazole, Glucocorticoids, Gold, Hydralazine, Ketoconazole, Penicillin, Quinidine, Sulfonamides, Tetracycline
Psychiatric	Anorexia nervosa, Factitious purpura, Gardner-Diamond syndrome
Pulmonary	No underlying causes
Renal / Electrolyte	Chronic renal failure, Uremia
Rheum / Immune / Allergy	Amyloidosis, Hypersensitivity vasculitis, Lupus, Rheumatoid arthritis, Sjogren’s syndrome, Leukocytoclastic vasculitis, Thrombotic thrombocytopenic purpura, Blood transfusion reaction
Sexual	No underlying causes
Trauma	Calcaneal petechiae
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Asphyxiation, Child abuse, Heat stroke, Senile purpura, Strangulation, Violent coughing, Amyloidosis

Causes in Alphabetical Order

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Differentiating Purpura from other Diseases

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Epidemiology and Demographics

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Risk Factors

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Natural History, Complications and Prognosis

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Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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[pmid10069314-1] Anderson JE, DeGoff W, McNamara M (1999). “Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature”. Pediatric emergency care. 15 (1): 47–8. PMID 10069314.

[pmid8340191-2] Lotti T, Benci M, Sarti MG, Teofoli P, Senesi C, Bonan P; et al. (1993). “Psychogenic purpura with abnormallt cutaney increased tPA dependeny”. 32 (7): 521–3. PMID 8340191. Unknown parameter |journous fibrinolytic activital= ignored (help)

[1]

[2]

Purpura

Overview

References

References

References

Pathophysiology

References

Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

References

References

References

References

References

Diagnosis

Treatment

Case Studies

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